Balance and Mobility Impairment in Older Adults with Cardiovascular Disease Before and After Rehabilitation: A Narrative Review.

Balance impairment threatens mobility and independence in older adults with cardiovascular disease, yet cardiac rehabilitation (CR) has traditionally prioritised aerobic capacity and cardiovascular outcomes. This narrative review examines the mechanisms and assessment of balance impairment, balance recovery within CR, and implications for clinical practice. Balance impairment reflects interactions among musculoskeletal, sensory, cognitive-motor, and cardiovascular constraints that affect different domains of postural control to varying extents. Standardised clinical measures do not capture these domains equally, and single scores or completion times can obscure the deficits underlying poor performance. Instrumented and wearable technologies extend clinical assessment by quantifying postural sway and gait, helping to distinguish broader mobility gains from recovery within specific balance domains. To translate this distinction into practice, this review recommends individualised, balance-focused CR, with assessment guiding task-specific training and virtual reality or exergaming providing graded practice and performance feedback to promote mobility and independence.